AJR Am J Roentgenol 2000 Apr;174(4):1041-7
Pulmonary embolism revealed on helical CT angiography: comparison with
ventilation-perfusion radionuclide lung scanning.
Blachere H, Latrabe V, Montaudon M, Valli N, Couffinhal T, Raherisson C, Leccia F, Laurent
F
Department of Radiology, Unite d'Imagerie Thoracique et Cardiovasculaire, CHU Bordeaux,
Hopital Cardiologique Haut-Leveque, Pessac, France.
OBJECTIVE: We compared helical CT angiography and ventilation-perfusion radionuclide lung
scanning as initial tests in the diagnosis of acute pulmonary embolism. SUBJECTS AND
METHODS: Two hundred sixteen consecutive patients who were clinically suspected of having
acute pulmonary embolism underwent helical CT angiography, ventilation-perfusion
radionuclide lung scanning, and Doppler sonography of the veins of the legs. On the basis
of concordance of the results for ventilation-perfusion radionuclide lung scanning and
helical CT angiography and on the degree of clinical suspicion, certain patients underwent
pulmonary angiography. Patients without pulmonary embolism at initial evaluation in whom
no treatment was instituted were followed up for at least 3 months to determine the
potential recurrence of thromboembolic disease. RESULTS: Of the 216 patients, 37 (17%)
were excluded because of insufficient data to assess the initial event. Final diagnosis
for the 179 remaining patients was pulmonary embolism in 68 (37.9%) and no pulmonary
embolism in 111 (62.0%), based on pulmonary angiography in 23 patients (12.8%) and
concordant imaging findings and outcome in the remaining patients. Statistically
significant differences (p < 0.05) were found between sensitivity, specificity,
positive predictive value, and negative predictive value for helical CT angiography and
ventilation-perfusion radionuclide lung scanning (94.1% versus 80.8%; 93.6% versus 73.8%;
95.5% versus 82%; and 96.2% versus 75.9%, respectively). Interobserver agreement was
excellent for helical CT angiography (kappa = 0.72) and moderate for ventilation-perfusion
radionuclide lung scanning (kappa = 0.22). CONCLUSION: Helical CT angiography could
replace ventilation-perfusion radionuclide lung scanning as the initial test for screening
patients who are clinically suspected of having pulmonary embolism.
PMID: 10749247, UI: 20210805
